Editor 's note : Dr. Vance Harris is a primary care physician in Redding , California . An earlier version of this commentary was posted on SERMO.com , a private , physicians-only online community .

Dr. Vance Harris says primary care doctors get minuscule payment for saving the system huge sums of money .

-LRB- CNN -RRB- -- Health policy experts agree that any reform in our health care system must include a well-educated , caring primary care doctor who is able to manage the health of his or her patients with an eye to using resources optimally to keep costs down .

That 's a tall order and it seems that few policy makers realize the value of primary care physicians .

People are making a huge assumption in this reform effort that as we extend coverage to millions who do n't have health insurance , there will be doctors there to actually provide the health care . Fewer and fewer medical students are choosing primary care and many primary care doctors are leaving the field .

Let me share with you why we are losing so many primary care doctors . What follows are a few examples I experience each week .

How many dozens of chest pain patients have I seen in the last month for whom I did n't order an EKG , get a consult , set up nuclear imaging or send for a catheterization ?

Only I have the advantage of knowing how anxious some are and that they have had similar symptoms over the last 20 years . After a history and exam , I am willing to make the call that this is not heart disease . In doing so , I save the system tens of thousands of dollars .

Most of these patients are worked into a busy day , pushing me even deeper into that mire of tardiness for which I will be chastised by at least six patients before the end of the day . My reward for working these people in and making the call is at most $ 75 .

How many times has an anxious patient come in demanding an endoscopy who I examined and then decided to treat less invasively for three to four weeks first ? Few of these patients are happy no matter how many times I explain that it is reasonable to treat their reflux symptoms for several weeks before endoscopy .

This delay in referral has led to many tense moments in the last 20 years . The cost savings to the system is thousands of dollars each and every time I am willing to make the call and go with the treatment . My reward is about $ 55 from Medicare and private health insurers .

How many low back pain patients have come to the office in agony knowing that there has to be something serious to cause this kind of pain ? A good history and exam allows me to reassure the patient that there is nothing we need to operate on and that the risk of missing anything is low .

This takes a lot of time to explain as I teach them why they do n't need an MRI . If someone else ordered the MRI , guess who gets to explain the significance of bulging disks to an alarmed patient ? Setting realistic expectations on recovery and avoiding needless imaging helps saves the system thousands of dollars . My reward is another $ 55 .

How many diabetics do I struggle with , trying to get them to take better care of themselves ? How many hours have I spent with teenage diabetics who will not check their blood sugar and forget half of their insulin doses ?

Hundreds of hours seem wasted until one day they open their eyes and want to take care of themselves . My reward for years of struggle is a few hundred dollars at best . The savings to society for my hard work and never-give-up attitude is in the tens of thousands of dollars .

I am in my 22nd year in practice , now caring for 3,600 patients . Having me in the system has resulted in savings in the hundreds of thousands of dollars each and every year . My financial incentive to hang in there and work harder is that I now make less than half what I did 20 years ago . This year I will make even less .

These are the reasons so many physicians have left medicine entirely and most of us who are left wonder how long can we continue to work like this ? I have always served my fellow man out of a sense of love and compassion . That 's why I went into medicine .

I have been richly rewarded by my patients over the decades as they have appreciated my judgment and skills . Is n't it a shame that after all this time and with skills honed by decades of experience , many of us can no longer afford to work as a physician ?

No one is talking about this on the national level . If they do n't address these issues , then good luck having physician assistants provide the safety net with two years of training . Good luck getting newly trained physicians once they see our salaries . Good luck finding internists in your community with only 1 percent of medical students going into internal medicine .

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020 , according to the American Academy of Family Physicians . And nearly half of all doctors surveyed by the Physicians ' Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely .

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself . Now that is ironic . Anyone know who is taking new patients in California ?

The opinions expressed in this commentary are solely those of Vance Harris .

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Dr. Vance Harris : Health care reform assumes doctors will be available

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He says primary care doctors are dropping out of the business

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He says he saves the system big bucks but gets only small payments

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Harris : My financial incentive is less than half what it was 20 years ago